SEPTEMBER – NOVEMBER 2019 • MCI (P) 108/12/2018

Forming a community of care for patients Doing more together HONOURING THE MULTIDISCIPLINARY TEAM IN HOSPICE CARE

PLUS Tips for caregivers

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 CHIEF EXECUTIVE’S NOTE Members’ Contacts Contents Alone, we can do so little. Assisi Hospice St Luke’s Hospital 832 Thomson Road, S(574627) 2 Bukit Batok Street 11, S(659674) T: 6832 2650 F: 6253 5312 T: 6895 3216 F: 6561 3625 www.assisihospice.org.sg www.slh.org.sg Together, we can do so much. [email protected] [email protected]

Bright Vision Hospital Tsao Foundation iven the complexities of capability, the synergy to improve aspects of 5 Lorong Napiri, S(547530) 298 Tiong Bahru Road multimodality treatment activities for living, coping and functioning T: 6248 5755 F: 6881 3872 Central Plaza, #15-01/06, for patients, no one medical is achieved. www.bvh.org.sg S(168730) G [email protected] T: 6593 9500 F:6593 9505 professional can possess all In essence, it is all about care and support to tsaofoundation.org the necessary background to make optimal help such individuals through everyday living. Buddhist Compassion Relief [email protected] treatment decisions independently or avoid Similarly, The World Hospice and Palliative Care Tzu Chi Foundation (Singapore) 10 inevitable unconscious bias toward their own Day (WHPCD) 2019, a unified day of action, aims 9 Elias Road, S(519937) Changi General Hospital area of expertise. to celebrate and support hospice and palliative T: 6582 9958 F: 6582 9952 2 Simei Street 3, S(529889) 2 Members’ Contacts Therefore, the composition of our care around the world. www.tzuchi.org.sg/en T: 6788 8833 F: 6788 0933 Multidisciplinary Team (MDT) is dynamic — a Let us echo the importance of recognising www.cgh.com.sg team of professionals that often goes beyond the professionals and individuals who have Dover Park Hospice 3 Chief Executive’s Note 10 Jalan Tan Tock Seng, S(308436) Khoo Teck Puat Hospital the call of duty, so dedicated are they to made an impact on and paid attention to T: 6500 7272 F: 6254 7650 90 Yishun Central, S(768828) The final goodbye address the sector’s needs. The members’ MDTs prioritising palliative care and services. On this www.doverpark.org.sg T: 6555 8000 F: 6602 3700 4 have brought together more than their own note, I am very pleased to announce that the [email protected] www.ktph.com.sg professional activities in a shared workspace, Singapore Hospice Council has now 20 member 6 A day in the life of... emphasising the value of aligned goals and organisations that actively provide palliative care HCA Hospice Care KK Women’s and Lyndsay Mathews, objectives, delivering a coordinated service in Singapore. The three new additions are: 705 Serangoon Road, Block A #03-01 Children’s Hospital @Kwong Wai Shiu Hospital, S(328127) 100 Bukit Timah Road, S(229899) pastoral counsellor to patients, their families and even training 1. Buddhist Compassion Relief Tzu Chi Foundation T: 6251 2561 F: 6291 1076 T: 6394 8008 F: 6291 7923 peers and allied health users with the relevant 2. Tsao Foundation www.hca.org.sg www.kkh.com.sg Doing more together knowledge to better enhance the deliverables of: 3. Woodlands Health Campus [email protected] 8 • Culture, collaboration and shared decision- Ng Teng Fong General Hospital making processes in patient-centred care You can read more about them on page 24 of Metta Hospice Care 1 Jurong East Street 21, S(609606) 10 Live Well. Leave Well. • Physician integration this issue. 32 Simei Street 1, T: 6716 2000 F: 6716 5500 • Shared information technology and access to Certainly we can concur — alone, we can do so Metta Building, S(529950) www.ntfgh.com.sg T: 6580 4695 F: 6787 7542 [email protected] 15 Going the extra mile patient data little; together, we can do so much. Will you be www.metta.org.sg • Addressing the concerned population there also to make our voices heard in a wave of [email protected] National Cancer Forming a concerts to raise awareness and understanding Centre Singapore 16 Good multidisciplinary work is made possible of the needs — medical, social, practical, spiritual MWS Home Hospice 11 Hospital Drive, S(169610) community of care with empowerment, dedication, leadership and, — of people living with life-limiting illness and 2 Kallang Avenue, T: 6436 8183 F: 6220 7490 for patients most of all, timely intervention and decision- their families? Come and join us as we celebrate CT Hub #08-14, S(339407) www.nccs.com.sg making. This is usually derived through shared WHPCD on Saturday, 5 October 2019 at *SCAPE, T: 6435 0270 F: 6435 0274 experiential learning, deliberation as a team Orchard from 12pm to 6pm! www.mws.sg Tan Tock Seng Hospital 18 The touch of love [email protected] 11 Jalan Tan Tock Seng, S(308433) with the interest of the patients and caregivers T: 6359 6477 F: 6359 6294 The root of at heart. There is respect for professional Ms Evelyn Leong Singapore Cancer Society www.ttsh.com.sg 20 expertise which is applied in a plan. With Chief Executive 15 Enggor Street, #04-01, palliative care clarity about each team member’s roles and Singapore Hospice Council Realty Centre, S(079716) Woodlands Health Campus T: 6221 9578 F: 6221 9575 9 Maxwell Road, www.singaporecancersociety.org.sg MND Complex Annex A, 22 Taking time to care [email protected] #03-01A, S(069112) T: 6357 7859 24 Upcoming Events & St Andrew’s Community Hospital www.whc.sg 8 Simei Street 3, S(529895) Announcements T: 6586 1000 F: 6586 1100 Lien Centre for Palliative Care www.sach.org.sg Duke-NUS [email protected] Medical School Singapore 8 College Road “Life’s most persistent and urgent question St Joseph’s Home Level 4, S(169857) “ 36 Jurong West St 24, S(648141) T: 6516 4233 T: 6268 0482 F: 6268 4787 www.duke-nus.edu.sg/lcpc is, what are you doing for others?” www.stjh.org.sg [email protected] — Martin Luther King, Jr.

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 END GOALS

Opposite and this page: The palliative team gathers thrice a week to discuss patients’ conditions for the past 24 hours, Dr Loo Yu Xian has been caring for With the Huddle in play, the palliative patients for “ the past three years palliative team can send the right person to help because every staff has different strengths and services that they can bring in.”

well, each member of the team This Huddle ensures that the families.The Huddle can also be a contributing their strengths and team would not go more than two support platform for members to expertise to the situation. days without being updated on check on each other, offer support The wife passed away that how patients are doing. In doing and to spark discussions on how very night, but both of them so, the team experience benefits care can be better delivered. got the chance to say their final that arose for both patients “Patients benefit from the goodbyes. The husband was also and staff. Huddle as the team is empowered able to make arrangements for Depending on patients’ needs, to deliver person-centred care. his wife’s funeral. with the Huddle in play, the team This requires additional effort The team was happy for the is able to send the right person to from every member of the couple to have their final meeting, handle the situation. This allows multidisciplinary team, but at as they could sense the value it the team to be more efficient in many times the reward proves had for both of them. care delivery while also reducing worthwhile, just as it did in this “None of us could have done the blindspots to issues that case of reuniting a couple before this alone because of the critical matter most to patients and the final departure. The final goodbye timing. Having the Huddle The recently established Palliative Huddle at Bright Vision Hospital, allowed us to come together and coordinate team-based efforts,” where a multidisciplinary palliative team gets together three times a explained Dr Loo. week to discuss the patients’ previous 24 hours, was instrumental in HOW THE PALLIATIVE HUDDLE bringing about an end-of-life couple’s last meeting. WAS BORN The idea of a Palliative Huddle stemmed from the team’s overseas study trip to heirs were two As a generalist in a community passing moment and the team St Christopher’s hospice in the UK. hearts separated hospital with an interest in resolved to work together to bring While it was not something new, T by an unfortunate end-of-life care, Dr Loo has been about this reunion. the Huddle was a step-up from twist in life. The wife caring for palliative patients for Using the Palliative Huddle as what was the norm in BVH. in Bright Vision Hospital (BVH) the past three years. “We knew a platform, the multidisciplinary The challenge was to catch was diagnosed with advanced her husband was getting referred team updated each other on everyone at a common timing, dementia and cancer, and her to us but we did not know the the situation and made plans not always easy as the medical, husband was receiving treatment exact day and time. As a team, to coordinate the reunion by nursing, social work and for cancer at another hospital. The we kept a look out for this as working with other colleagues in rehabilitation teams were on care team knew that the husband we knew it would be of utmost the hospital. different schedules. will be admitted to BVH for importance to reunite them,” They knew that teamwork “It was not easy to gather palliative care and thought that it he shared. But as time went would be an integral component, everyone. We currently meet would be a good idea to reunite by, the patient’s condition and thanks to the combined three times a week, but our the couple. Associate Consultant deteriorated and her husband’s effort from everyone, the couple aspiration is to move towards Dr Loo Yu Xian was the doctor-in- admission was delayed. Things eventually met. The team ensured having a daily Huddle.,” said

charge of the couple’s care. did not look too good with each that the admission process went BRIGHT VISION HOSPITAL AND PHOTOS WORDS Dr Loo.

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 PEACE OF MIND

‘A day in the life’ of… Lyndsay Mathews, the new Pastoral Counsellor at Dover Park Hospice, is part of the multidisciplinary team that takes care of patients’ spiritual needs. We find out what a day’s work would involve.

How long have you been with Dover Park Hospice? What are some of the challenges you face in I joined Dover Park Hospice in January 2019. Prior your job and how do you overcome them? to my current stint, I had undergone training As this is a new role at the Hospice, we are all in the USA to provide spiritual care to patients learning how my skillset fits into the larger in a hospital setting. I find the work incredibly team. Everyone has been incredibly welcoming meaningful. I was thrilled when I saw the job and willing to work together to see how my listing for a pastoral counsellor at Dover Park role can benefit our patients and their families. Hospice, and applied immediately! Another challenge stems from the fact that I am not a local. Sometimes, there are cultural What does a pastoral counsellor do? differences that I do not fully understand or Pastoral counsellors provide spiritual care to languages that are new to me. However, I try to patients and their families. Spiritual care is overcome this by taking a posture of learning. about journeying with others, providing a I learn from my co-workers, my patients, listening ear and reflecting on what the person and their family as they teach me about values and finds meaningful in their life. Unlike local culture and values. (Also, my Singlish is what most people would expect, spiritual care definitely improving!) can be given regardless of race or religion, or in I’m incredibly grateful to be able to absence of religion. Every one of us, regardless of experience life in Singapore and to have the these identifiers, have a search for meaning privilege of journeying with those who are in life. nearing the end of their lives through my role at Dover Park Hospice. What’s a typical day like? I split my time between visiting patients and family members, both in our Inpatient and Home Care service. I also participate in our “Multiple Disciplinary Rounds”, when our team of doctors, nurses, medical social workers, therapists and rehabilitation team members meet to discuss how we can best care for our patients. Further, I support various activities in the Hospice by helping out with group work such On a daily basis, I as art therapy, music therapy, “Lim Kopi” sessions “ and our Namaste Care group. On top of various administrative duties such as charting, these encounter human responsibilities can keep me quite busy! resilience and How has it been working at DPH? It has been a very rewarding experience. I view my time with each person as a gift. One of my amazing love most indelible experiences was being present at a patient’s house when she passed away. Bearing between family witness to the family’s love for their mother at the end of her life was extremely touching. On a daily basis, I encounter human resilience and amazing members and friends love between family members and friends that transcend words. that transcend words.” HOSPICE PARK DOVER AND PHOTO WORDS

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 PALLIATIVE HOME CARE

PAlliative Care for the Terminally-ill non-cancer and fluctuating clinical conditions. While it is patients) was started at Khoo Teck Puat Hospital important to deliver patientcare and medical Doing more together in September 2018. It is a home palliative care help, the Programme IMPACT MDT also strives Khoo Teck Puat Hospital’s Programme IMPACT is a home palliative care service service that delivers end-of-life care through a to reinforce their patients’ personhood, multidisciplinary home palliative care team and recognising that their dignity and comfort are that aims to reduce re-admissions and keep patients comfortable at home. aims at caring for non-cancer patients with ESOF also important as they prepare to leave well, of the heart, lungs and kidneys, specifically. and this can only be done best when more is As these patients have a prognosis of six done together. months or less, the programme’s main outcomes It is worth remembering what Andrew are reducing unnecessary re-admissions to Carnegie, the famous philanthropist, said, the hospital and keeping the patient comfortable “Teamwork is the ability to work together at home. Hence, it is essential for each member toward a common vision. The ability to to have a committed patient-owned and direct individual accomplishments toward person-centric care. organisational objectives. It is the fuel that As ESOF patients are in the final stages of allows common people to attain uncommon life, they may have unpredictable prognoses results.”

Members on Programme IMPACT

Specialist Consultant: This is the doctor who refers the as possible. With the doctor and nurse, the MSW can patient to programme IMPACT. As the patient would have also complete a Preferred Plan of Care as part of the been managed by this specialist for a relatively long period patient’s Advance Care Planning. of time, the input of this doctor is vital for continuing the quality care of the patient and caregiver, especially when Team Allied Health Staff: The role of the the patient has to be cared for at home. Physiotherapist (PT), Occupational Therapist (OT) and Speech Therapist (ST) depends on the needs Team Administrative Staff: The referral is usually received of the patient and they can be activated accordingly. by the administrative staff who ensures that the required The PT can check if the patient’s muscles can be details have been given. They may also check on the strengthened by active or passive exercises; the OT can Medisave status of the patient as that can be used to defray ensure that the home environment is more patient- the costs of the home visits by the doctors and nurses. friendly by fixing hand rails, grab bars, and non-slippery flooring; and the ST can make sure the patient’s diet is Team Doctor: Whether a medical officer, resident consistent with the swallowing ability. physician or the consultant, this doctor visits the patient at home and liaises with the referral doctors whenever Team Health Care Assistant (HCA): The HCA required. The primary duty of this doctor is to ensure that supports the nurses, checks the patient’s parameters the patient’s symptoms like pain, breathlessness, nausea, during the home visit, and helps with communication or vomiting are well-controlled. They also look out for the when needed (for example, translation). patient’s family and help them cope as caregivers. Patient’s Caregiver at Home: A caregiver is also a ore Done Together” was exemplified Over the years, these MDTs have evolved to Team Nurse: Along with the team doctor, the nurse who vital member of the MDT as he/she is with the patient by Dame Cicely Saunders, who include caring for both non-cancer and cancer oversees the patient plans the frequency of the home visits most of the time at home. They help to monitor the “M founded the modern hospice and patients. Working together with organ specialists depending on the patient’s condition. He/she also ensures patient’s condition daily, ensuring that medication is palliative care movement. She in hospitals, MDTs have helped care for End- that the patient is comfortable at home and supports the taken as planned, and reports to the nurse or doctor was a one-woman multidisciplinary team (MDT): Stage Organ Failure (ESOF) patients wherever patient’s caregiver. if the patient’s condition changes at any time. It is trained nurse, almoner (today’s medical they may be — in an acute hospital, sub-acute important for the IMPACT team to help the caregiver social worker) and doctor. Her skills helped community hospital, specialist outpatient clinic her patients so much that she founded the or at home. As we look at healthcare today, Dame Team Medical Social Worker (MSW): The MSW looks understand the patient’s evolving clinical condition, St Christopher’s hospice in the UK in 1967, Cicely Saunders’ belief of doing more together as into the social, financial and emotional issues of the patient changing prognosis and their role in supporting the it was important that the services it provided — an MDT is still as relevant as it was 50 years ago. and family, and renders the required assistance as quickly patient at home. inpatient, home and day hospice — had Built on the same beliefs and principles,

strong MDTs. Programme IMPACT (Integrated Management & GERIATRIC SENIOR CONSULTANT, AKHILESWARAN, RAMASWAMY WORDS HOSPITAL PUAT KHOO TECK PHOTO HOSPITAL PUAT KHOO TECK MEDICINE,

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 COMMUNITY OUTREACH

Right photo (left-right): Secretary of South West CDC Mr Walter Lee, Mayor of South West District Ms Low Yen Ling, Senior Minister of State for Law and Health Mr Edwin Tong, Chairperson of SHC Dr Angel Lee, and former Chief Executive of SHC Ms Yeo Tan Tan, launching the Caregiver Resource Booklets and Life Book at the opening ceremony Other photos: More than 1,700 people visited the two-day event

Live Well. Leave Well. Singapore Hospice Council’s community outreach event continues to raise awareness of palliative care and the rich repository of resources available to support caregivers on their caregiving journeys.

ollaborating District Ms Low Yen Ling, was overcome the struggles and with South West graced by Senior Minister of challenges they may encounter on C Community State for Law and Health Mr their caregiving journey. Development Council Edwin Tong. SHC Chairperson Dr Angel Lee (South West CDC) for the first time, It takes a leap of faith for said, “Caregivers play a vital Singapore Hospice Council’s (SHC) caregivers to entrust their loved role in supporting seniors. By “Live Well. Leave Well.” community ones to others, as the feelings moving away from individual to engagement event reached out of guilt, and perhaps, anger and collective caregiving, SHC hopes to the residents living in the west frustration, take over. Some may to continue to work alongside region of Singapore. Together grapple with their newfound the Ministry of Health and South with SHC member organisations caregiving roles and struggle to West CDC to strengthen support and community partners, SHC provide the best care for their for senior caregiving.” SHC sees welcomed more than 1,700 loved ones. This is where SHC the importance of providing visitors on 11 and 12 May 2019 endeavours to fill the gap by support and resources to improve at the Westgate venue. The event, supporting and helping caregivers the lives of patients with serious

SINGAPORE HOSPICE COUNCIL SINGAPORE HOSPICE AND PHOTOS WORDS hosted by Mayor of South West manage their expectations and life-threatening illnesses and

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 COMMUNITY OUTREACH

Clockwise from right: Guest appearances by Vincent Ng, Shaun Chen, Li Nanxing By moving away from individual to and Constance Song; Ms Margarete Yong inspired the “ crowd with her caregiving journey, Ms Eslinda Hamzah collective caregiving, SHC hopes learned to administer medication and manage the medical equipment with the help of the Palliative Care to continue to work alongside the Team KTPH and SCS, in a session facilitated by Dr Teoh Ren Shang Ministry of Health and South West CDC to strengthen support for Resources launched at “Live Well. Leave Well.” senior caregiving.” — a caregiving community @ South West — SHC Chairperson, Dr Angel Lee

Life Book Granny Cool Granny Cool is the latest addition to the three-book series to raise awareness about palliative care by engaging the public with the community’s rich repository of stories. Inspired by true stories, each book is beautifully illustrated to be an easy read for all. Taking its readers on a discovery and to revisit palliative care from different perspectives (i.e. patients, caregivers, doctors, nurses, social workers, therapists and volunteers). We hope readers can better understand the holistic approach and multidisciplinary team in palliative care through these different lenses. Granny Cool tells the caregiving journey of Melisa with her cancer- stricken grandmother. Download the book (https://singaporehospice.org.sg/lifebook/) to read more about the optimistic and cheery duo. lighten the load for their and services available by the caregivers as they journey staff and volunteers at the Caregiver Resource Booklets together. Mr Tong shared in exhibition booths. There was The three booklets equip caregivers with tips on caring for their loved ones. his opening speech that based not a dull moment on stage. These booklets are designed to walk caregivers through the various stages of on the feedback gathered The elderly and shoppers were their caregiving journeys: from the Ministry of Health’s highly entertained by a variety interaction with caregivers, of songs and skits, educational caregivers’ stress derives from talks and sharing sessions by • Nutrition in Advanced Illnesses – The booklet contains tips and recipes not knowing what their loved healthcare professionals and to maximise your loved ones’ nutrition, comfort and quality of life especially ones want, especially at the caregivers and there were also when your loved ones have lost their appetite and are losing weight. Also end-of-life phase when they special appearances by celebrity included are a few food recipes. are no longer able to express artistes over the two days. • Understanding the Final Hours – The “final hours” refers to the period their wishes. He therefore Through community just before death occurs. It may range from the last hours to short days. This encouraged Singaporeans partnerships and media brochure will walk one through the process as one prepares to bid goodbye to normalise end-of-life engagement, SHC hopes to to a loved one. conversations as it is continue to develop more • Caring for Yourself after a Death – Grief is a natural response to loss. important to understand the resource materials in the future This booklet provides tips on how to help oneself as one grieves. values and care preferences of to generate public awareness their loved ones. and encourage Singaporeans These booklets can be downloaded from: https://singaporehospice.org.sg/caregiver/ At the event, visitors were to start discussing end-of-life introduced to palliative matters with their loved ones care, caregiver resources and to “Live Well. Leave Well.”.

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 COMMUNITY OUTREACH CAREGIVER ACCOUNT

The Singapore Hospice Council (SHC) created a month-long buzz in May 2019 to Going the extra mile debunk myths about hospice and get Singaporeans more comfortable talking about Caregiver Ms Eslinda Hamzah was thankful for the all-round death and encouraging them to plan for end-of-life care. Apart from the traditional care of the multidisciplinary team at Singapore Cancer Society and out-of-home advertising such as TV, radio, print, digital, table-top stickers and that eased the final journey for her aunt. bus shelter panels, the engagement on Instagram took the public by storm!

aregiving for the dying Society (SCS). Upon discharge, the increased. There were days requires sacrifice and SCS Hospice Care team seamlessly when my aunt just needed some commitment. It can settled us at home. quiet moments, and the nurses C be heartbreaking. What struck us most was the would just sit with her, holding However with awareness of the immediate bond that we formed. We her hands. assistance available and having the were heartened by the SCS Hospice The SCS doctors and nurses #LendYourInstagram right support system in place, it can Care team’s consistent, tireless will always attended to the family’s be an entirely different experience. to always go the extra mile, above welfare as well. Everything the As a family, we could not have and beyond the call of duty for my team did was geared towards managed without the outstanding aunt and family. The team provided helping us find acceptance OVER support of two teams of healthcare symptoms control, and emotional, for my aunt to pass on with To educate Singaporeans workers who never allowed us to social and spiritual support. as much dignity and as what life is like in palliative feel isolated as caregivers. The SCS Hospice Care team’s little suffering as possible. My aunt, Ms Rohana bte Ahmad regular visits greatly benefited They brought a great deal of 5 30 care settings,700,000 SHC posted influencers shortinfluencers quotes (and counting) became a hospice patient when us. They taught and guided me sensitivity and compassion with she was 55 years old, having been on the processes involved to be their services. (Pornsak, Suhaimi Yusof, and compelling views and over diagnosed with pancreatic head a caregiver for a hospice patient. The SCS Hospice Care team Chew Chor Meng, images of patients 80,000 shares cancer and liver metastases. She They were always empathetic and became an integral part of our was attended by Khoo Teck Puat encouraging. Their dedication lives as we experienced this Eswari Gunasagar and and healthcare (still counting) Hospital’s (KTPH) palliative team. taught us to better appreciate our journey with my aunt till she Jamie Yeo) visited professionals of the video which With their support, the quality of extraordinary healthcare workers passed away earlier this year. life improved for both my aunt and and the depth of work they do for We are eternally grateful to each hospices to learn a skill were posted by has gone viral with our family. our community. one of them and everyone else from the patients, and SHC to educate PM Lee Hsien The KTPH team referred my With their support, my who played a part in my aunt’s aunt’s case to Singapore Cancer confidence to take care of my aunt final journey. they exceeded their Singaporeans about Loong reposting usual engagement rate palliative care the video

OVERVIEW PERFORMANCE 2,403 966,195 8,399 WEBSITE UNIQUE VIEWS OF NEW CLICKS OUR POSTS FOLLOWERS 1,338,973 279,510 IMPRESSIONS OF UNIQUE LIKES, COMMENTS, OUR POSTS SHARES AND SAVES

*Figures are only totalled from our posts. It is not inclusive of the extended reach, impressions and engagements from thousands of people who have shared our posts. The numbers are still increasing by the day! CAREGIVER MS ESLINDA HAMZAH (FAMILY MEMBER OF LATE SINGAPORE CANCER SOCIETY SINGAPORE CANCER SOCIETY MEMBER OF LATE HAMZAH (FAMILY MS ESLINDA CAREGIVER WORDS SINGAPORE CANCER SOCIETY PHOTO BTE AHMAD) MS ROHANA PATIENT, SERVICE HOSPICE

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 SUPPORT SYSTEM

What is your greatest challenge? CY: We need to build rapport and strong relationships with patients. Forming a community When they start to deteriorate and eventually pass away, some deaths may hit us harder than others. What keeps me going is the knowledge of care for patients that there is a next patient who will The Allied Health Team is an integral part of the multidisciplinary team need me. No two patients are ever the same and with each, I take away at Assisi Hospice. We speak to Senior Occupational Therapist Ms Celine different lessons. Yong (CY) and Senior Music Therapist Ms Tammy Lim (TL) to find out TL: Oftentimes, patients, their families and even some members of more about their work for the patients and their families. my team think that I am a singer or musician! But of course, many begin to understand my role once they see me in action. Describe your roles in Assisi Hospice. CY: My primary role is to enable What gives you the greatest sense of patients to continue to enjoy and satisfaction about your role? participate in activities that are CY: I have always loved the process, important and meaningful to them, and the strength that comes in despite facing deteriorating health. I working with the multidisciplinary the chance to help him reframe Opposite page: Ms Celine Yong problem-solve, modify activities and team. I really value that I do not his expectations of himself. I had taking a walk in the environment so that the patient is work alone and that I get to witness the honour of journeying with him the garden with a patient; Above: empowered to participate in activities how each discipline contributes until the very end, witnessing his Ms Tammy Lim of their choice. and ultimately enhances the immense courage in the face of a conducting music therapy with a TL: I use music interventions such as patients’ stay here at Assisi Hospice. cruel disease. patient singing, instrumental playing, music- I give my time, skills and knowledge TL: Mr L was a 76-year-old assisted relaxation, songwriting or to patients and their families but gentleman who was a loner most of lyrics analysis to meet our patients’ in return, I am rewarded with his life and did not have friends nor about a final song that he wanted multidimensional needs. The common meaningful relationships with them family. His isolation worsened as me to sing for him called “迟来的爱” clinical conditions that music and they teach me so much about he developed a significant hearing (“The Love that Came Late”). I therapists address include physical living and dying. impairment. I discovered that knew instantly that it was his way discomfort, emotional distress, TL: My greatest sense of satisfaction Mr L loved music and, in particular, of thanking me and the team for neurological conditions, spiritual is when I can sense a beautiful chord karaoke. I finally set up a sound reaching out to him, never giving up needs, and imminent death. The striking in my clients’ hearts and system that gave him the ability to on him and loving him for who he ultimate goals are to enhance our minds! That’s when I know the music hear himself and the music, and was. In the end, I believe Mr L found patients’ quality of life and to promote has spoken to the person’s soul and to perform for others. He told me the self-worth he so deserved. a sense of dignity, through the power I will just let music do what it is of music. supposed to do. Music speaks the unspeakable. It is a time machine, What is unique about your roles in a and it can bring us to the past, stay palliative care setting? in the present, or imagine the future. Calling all Allied Health Practitioners! CY: The fact that our patients are In celebration of Assisi Hospice’s 50th anniversary, we will be organising a unlikely to get better. We have to Describe one memorable incident of symposium “Allied Health in Palliative Care: A Paradigm Shift in Care” for constantly think of new and creative your interaction with a patient. occupational therapists, physiotherapists, music and art therapists; especially ways to keep patients engaged in CY: I will never forget Mr M who things that are important to them. was very determined to walk for Allied Health professionals Inevitably, we need to address the and be independent. It was tough Date: Saturday, 26 October 2019 patients’ strong emotions, such as professionally because I had my Time: 9am-12.30pm anger and hopelessness. reservations and I was worried Venue: Assisi Hospice, Level 6 Essery Hall, 832 Thomson Road, TL: Music helps connect the patients about his safety. But we got to work with their family members, caregivers, and I did everything I could to Singapore 574627 friends, and healthcare staff. Being balance out the risk and benefits. Content: Panel discussion with Allied Health Therapists and workshop a music therapist, we empower Over time, he started to deteriorate. sessions catering to the respective professions everyone on this journey to embrace I thought that he would fight it, Free registration for Allied Health professionals at https://tinyurl.com/ the beauty of life through the lens but instead, he was the one who of music in the midst of chaos. told me that he could not carry on AHinPal by 23 September

When words fail, music speaks. ASSISI HOSPICE PHOTOS ANGELA YEO WORDS with his exercises. That gave me

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 CAREGIVER TRAINING

Caregiving is often a lengthy marathon, but with all hands on deck, HCA is able to soothe the hearts and souls of those we care for.

Participants are encouraged to HCA’s Patient Care Administrators HCA’s Medical Affairs try out techniques such as lifting make contact with patients department collates the and transferring on each other, in to establish the accuracy of registration for all the fortnightly order to build confidence when personal details such as their training sessions, ensuring a it comes to caring for their loved residential address. The patients seamless service flow to set ones at home. are then assigned to one of HCA’s patients and families at ease. The satellite centres or Day Hospices, Palliative Caregivers Training is FACILITATING THE TRANSITION depending on need and/or held either at HCA’s headquarters Most of HCA’s patients are referred geographical location. or at patients’ homes, if from acute hospitals to their After a home visit to find needed. Caregivers are given a homes, a transition that can be out more about the patients comprehensive guidebook and overwhelming and disconcerting and their families’ needs and caregiving demonstration videos for patients and their families. dynamics, the primary care are also available on the HCA Rather than a futile endpoint, the nurse will then recommend website for easy reference. holistic support HCA provides is that the patients’ caregivers Caregiving is often a lengthy Touch Therapy is an important akin to a comfortable and homely attend the Palliative Caregivers marathon, but with all hands on aspect of palliative caregiving as it creates feelings of closeness rest stop on a long-drawn journey. Programme if they are not deck, HCA is able to soothe the between caregiver and patient Following HCA’s internal triage familiar with caregiving, or hearts and souls of those we

process after a referral is made simply need a refresher. care for.

The touch of love Tips for Caregivers DR JAMIE ZHOU Since the start of the Palliative Caregivers Programme by HCA Hospice Care, Consultant, Division of Supportive and Palliative Care the fortnightly training of caregivers by nurses have enabled patients with National Cancer Centre, Singapore

life-limiting illnesses to spend the remainder of their days at home. This issue of Hospice Link focuses on the multidisciplinary Palliative Care team. As caregivers, you are very much part of the multidisciplinary team! In fact, your perspective gives the team much insight to ormer First Lady of It is a great personal commitment caregivers with the requisite the patient. Here are some tips on what will be helpful the United States, that demands time, energy and the skills to care for their loved ones to share with the team: F Rosalynn Carter once support of others. at home. The fortnightly training said, “There are only For the caregivers of HCA Hospice covers a comprehensive spectrum #1: Share the caregiver challenges you face at home #3: Identify anyone who may require four kinds of people in the world. Care’s (HCA) patients, it is a final act of topics related to palliative The challenges you face at home with caregiving may additional support Those who have been caregivers. of love that is charged with mixed caregiving, including basic hand not be apparent to the team unless it is highlighted. It is important to identify anyone who may require Those who are currently caregivers. emotions as they prepare for the hygiene, oral care and feeding, You can volunteer the information and the team may be additional support, whether in terms of physical, Those who will be caregivers, and last lap in the familiar sanctuary lifting and transferring, and urinary able to address these challenges with appropriate support emotional, or spiritual. This may be a blindspot for the those who will need a caregiver.” of home. HCA is very much part of catheter care. It takes the unity of a community that community, journeying with Conducted by HCA’s nurses, or services. team and if it is raised earlier, the team may be able to to enable patients with life-limiting families and providing clinical and the five-hour session provides address and support the person appropriately. Some illnesses to spend their remaining psychosocial support at no charge. participants with the opportunity #2: Share about who the patient is as a person forms of support are: days in the comfort of their home, for hands-on practice. “Participants An insight to the patient’s personhood is extremely valuable. • Physical: equipment loan, caregiver training, etc surrounded by their loved ones. PALLIATIVE CAREGIVERS get to take turns to practise It helps the team deliver more person-centred care. For • Emotional: counselling, professional psychological Caregiving is often an offshoot PROGRAMME what they have learned on the example, you may want to tell the team that ‘my father is a help, etc of relationships — it stems from HCA’s Palliative Caregivers mannequin, to simulate a real-life very clean person’, or ‘he never likes to trouble others’. • Spiritual: religious support, meditation, etc a sense of duty and love to those Programme started in 2004 caregiving situation,” HCA Director

with whom we share a close bond. with the objective of equipping of Nursing Angela Tan said. CARE HCA HOSPICE AND PHOTOS WORDS

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 PALLIATIVE NURSING The root of palliative care Staff Nurse Koh Ker Sin shares her experience working with MWS Home Hospice patients and talks about her passion for palliative care nursing.

Why did you decide to become a and do a thorough physical home hospice nurse? examination. At the same time, When I was an oncology nurse, I we will watch out for emotional realised I did not have enough time and non-verbal cues to pick up on to talk to patients and get to know any issues that they may not be them and their stories. Now, as a comfortable putting into words. nurse providing palliative care, I’m Besides managing the medical and Staff nurse Koh Ker Sin able to do what I love: speaking nursing aspects, we have to evaluate provides nursing to patients one-to-one and getting their psychosocial well-being which care to MWS Home Hospice to know more about them. Home affects how we care for them. patient Mdm Hospice work has also allowed me We also go through their Haliza bte Jantan during a to hone the nursing and diagnostic medication regularly to make home visit skills I picked up for my Specialist sure both the patients and their Diploma in Palliative Care Nursing. caregivers understand the regime and potential side effects. What is your most memorable worker, we helped him to reconcile eye and he whispered in a weak Is there anything about palliative What was your first home visit like? Before each visit, we call our experience working with patients? the relationship. He was pleasantly voice, “Thank you.” Afterwards, I care that you wish more people My very first home visit was to a patients to check for any new One of my most memorable surprised that I noticed this even called his son and told him things knew about? MWS Home Hospice patient with symptoms and how they’re doing. experiences was working with though he did not mention it at did not look good. The patient’s son I wish that when people hear about breast cancer. She had a large This enables us to better prepare a patient who passed away in all. From then on, I sensed that he called me that evening to inform me palliative care, they wouldn’t think, fungating wound over her chest for the visit such as bringing along 2014. He was a 60-year-old man trusted me and began to confide that his father had passed on. At his “Oh, the patient is going to die soon.” wall with metastases to her ribs medication that the patients may diagnosed with lung cancer which in me more. His wife told me that wake, when I saw the peace on his Instead, I would like them to think and lymph nodes that resulted need. We also do follow-up phone had spread to his bones. A man of whenever he knew that I would be face and felt the gratitude expressed about the quality of life they would in poor lymphatic drainage. Her calls after our visits to check on few words, he was quite suspicious visiting, he would sit by the window by his family, I told myself I had like to have when they are unwell. left arm was very swollen with patients who have started on of me initially. I visited him twice a to wait for me. done a good deed. I felt that I also Palliative care is a very holistic discharge oozing from it. I saw how strong opioids on the same day or week as he suffered from worsening I still vividly remember the day received the closure to move on. approach to taking care of patients. my doctor did a holistic assessment following day to find out if there symptoms such as breathlessness that he died. I visited him that day We take care of patients as a whole and dressed her wounds patiently. were any side effects and the and pain. Over time, I observed that but he was not very responsive. He What are some of the challenges you person, addressing their physical, I was touched by the doctor’s effectiveness of the medication in he had some issues with his wife was unable to speak and was in a face as a home hospice nurse? emotional, social and spiritual needs. reassuring words, the patient’s relieving discomfort. and together with my medical social very drowsy state. His wife wanted We are often on our own during It is about how to make happy facial expression, and her words to bring him to the bathroom to home visits and most people think memories till the very last day. of gratitude that she finally met bathe but I advised her not to as that as a nurse, you should know someone who understood how he was very ill. Instead, I told her every medical-related issue. We Do you have any advice for she truly felt. At the same time, I to prepare a pail of warm water have to read more in order to those interested to work in was saddened and felt that better to clean him. He struggled a little answer questions from patients palliative care? nursing care could have been when I first started to clean him and their families, conduct better Palliative nursing has taught me delivered to her earlier to relieve but I held his hand and said to him, assessments, and be more accurate a lot and changed my perspective her suffering. We take care of patients as a “I’m KS. Trust me, I will make sure in our diagnosis. on life. It gives me a sense of “ you are clean and comfortable.” I have also learned that rapport satisfaction and achievement when Could you describe what you do whole person, addressing their Upon hearing that, he relaxed and and trust are very important. patients transform from being during home visits? allowed me to continue. Next, I When these are established, strangers to trusting you with their A typical home visit is like visiting a combed his hair, shaved his face, discussions with patients and lives. Most importantly, you must friend who is feeling unwell on top physical, emotional, social and changed his diapers and their loved ones and getting truly care about the patients to of assessing them comprehensively. bedsheets. When I finished, I saw a them to follow your advice establish trust. This is the root of

We take a history of their concerns and spiritual needs. SERVICES METHODIST WELFARE & PHOTO WORDS tear falling from the corner of his become easier. palliative care — compassion.

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 FINDING A CALLING AN OPEN LETTER

Samuel Hepzibah Beulah (below: on the right with her mother) wanted to be a palliative care nurse To: My Fellow Human and graduated with a Specialist Diploma in Re: Reaching Out With Our Hearts In Our Hands (A pledge to patients with Palliative Care Nursing life-threatening illness) In commemoration of World Hospice and Palliative Care Day on 12 October 2019

Dear Fellow Human,

Thank you for allowing us into your life. Surely, many thoughts and questions are swirling in your head as you come to terms with events unfolding in your life. You feel helpless, afraid and wonder if anyone cares at all. We pledge not to abandon you. In fact, we will pursue you because you matter to us. Our care is total and unwavering.

Your anxieties, fears and worries are important to us. So are your dreams, hopes and prayers, which you must cling on to especially when the hour seems darkest and your life spirals out of control. We will work with you and your loved ones to soothe and comfort the pain, in whichever form it takes. We will always be by your side. Don’t ever think that you will be a burden to us or your loved ones. To be given the opportunity to care for you is a privilege. By being part of our life’s journey, you are teaching us personal growth too as we learn Taking time to care to treasure life and our own family members. Most importantly, we learn to After moving more than 6,000km from her home village, palliative care face our own mortality with strength and courage. nurse, Samuel Hepzibah Beulah, has found her calling in St Luke’s Hospital. Tell us how to care for you — today, tomorrow and the days that follow. We will honour your wishes and help you live on your terms. Don’t feel bad if, sometimes, you contemplate a quickened death, as life becomes a struggle hen she was young, In 2017, St Luke’s Hospital was in Singapore dedicated to the between hope and futility. Forgive us though, as the power to prolong or Samuel Hepzibah elderly sick. preparing to open its dedicated Beulah accompanied The hospital had started admitting palliative care ward. Hepzibah shorten life is not ours to have. We will walk with you at your pace, without W her mother to visit the patients for palliative care and wanted to be a palliative care nurse hastening or delaying your journey. Your life is like a warm, glowing candle that elderly who needed medical help in Hepzibah had the chance to care and went for further studies. She is precious to all within its circle. We could never bring ourselves to snuff their village in Tamil Nadu, India. graduated with a Specialist Diploma for end-of-life patient Madam Lee out that light prematurely. Due to the lack of medical facilities (not her real name) for a month in Palliative Care Nursing and in 2018, and awareness among the villagers, in her ward. Hepzibah helped she started working in the hospital’s her mother, a nurse, would provide with activities of daily living, palliative ward. Your family and friends will miss you tremendously when you are no longer nursing care, bringing low-cost or wound care and assessing the Besides gaining palliative care around but, when the storm abates, they will rediscover you alive in a corner free medicine, and taking those nursing skills, Hepzibah has also need for pharmacotherapy. of their hearts. They will treasure the fond memories you left behind with who need more treatment to Hepzibah also interacted with developed her character. She said, hospital. Hepzibah was inspired to Madam Lee to find out her wishes, “Palliative care is different from them and the grief that they feel now will give way to an everlasting love that follow in her mother’s footsteps. and relayed them to her family and general nursing care. We need to transcends space and time. There will be great anticipation of a reuniting of all When Hepzibah’s grandfather had the multidisciplinary team. They know how to give the right kind of the departed in the not-too-distant future. colon cancer, he suffered greatly. worked together to help colour her care that palliative-cared patients There was no palliative care in the hair and nails, which was what need. I have also learnt to slow down village. Hepzibah said, “He would she used to do. When Madam Lee and take the time to attend to such As for us, we will cherish the memories of having walked with you on your ask anybody who passed by his looked good, her mood was also patients, to be more sensitive to final journey and how you have touched us and taught us the importance room for a knife so that he could better. As she wanted to taste fast their needs and to put myself in of being human again, and to bring us back to our roots — of curing end his life.” He passed away in food and coffee, these were brought their shoes.” sometimes, relieving often and comforting always. severe pain. to her. The music therapist also As working in palliative care can Hepzibah came to Singapore in offered support and facilitated be emotionally challenging, Hepzibah 2010 when she was 29 and worked communication. Hepzibah realised is thankful for the support from her Associate Professor James Low Yiew Hock, as a registered nurse. In 2012, that comfort and psychosocial care colleagues. She also finds meaning in Senior Consultant, Khoo Teck Puat Hospital she started working in St Luke’s were very important for palliative- being able to fulfil patients’ wishes,

Hospital, the first hospital cared patients. including their last wishes. HOSPITAL ST LUKE’S & PHOTOS WORDS

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019 CALENDAR Upcoming Events & Announcements

5 OCTOBER 2019 “Live Well. Leave Well.” — Voices of My HeART” Welcome to SHC! By Singapore Hospice Council Singapore Hospice Council (SHC) welcomes three new members who actively provide A community outreach for the palliative care in Singapore, making it a total of 20 members as of 30 May 2019. young and the young-at-heart, to raise awareness about palliative care through the creative arts — Buddhist Compassion Relief Tzu Chi Foundation (https://www.tzuchi.org.sg/en/) song competition, dance, interactive With over 50 years of rich history worldwide, and a locally registered charity booths, movie screening and established in 1993 in Singapore, Tzu Chi Foundation’s key focus is to promote dialogue. We also commemorate charitable activities, medical services, and humanistic and environmental education World Hospice and Palliative Care and culture, to meet the local society’s needs and demands. Day — a unified day of action to celebrate and support hospice and Tsao Foundation (https://tsaofoundation.org/) palliative care around the world. Venue: *SCAPE, 2 Orchard Link, Founded in 1993, the Tsao Foundation is a non-profit organisation dedicated to Singapore 237978 improving the quality of life of older persons in an inclusive society. Community-based Time: 12pm to 6pm medical and psychosocial programmes and services; research, dialogue and collaboration Web: singaporehospice.com.sg/ with community, academia and public service agencies; and training and education events programmes empower eldercare colleagues, older persons, caregivers and the public.

12 OCTOBER 2019 Woodlands Health Campus (http://www.whc.sg/) The Dandelion Ride By HCA Hospice Care Slated to open in December 2021, the 1800-bed purpose-built Campus will Venue: Great Eastern Centre, 1 integrate an acute hospital, community hospital and long-term care facility within the Pickering Street, Singapore 048659 same development. This will allow patients to move seamlessly between the different Start Time: 6am care settings. Catering to the needs of patients with life-limiting illnesses, the Campus Contact: Ms Mei Basuki, Fundraising Manager, will have a total of 70 palliative care beds: 50 in the inpatient hospice and 20 in [email protected], the community hospital. 6891 9508

EDITORIAL COMMITTEE

Editor Christina Wee Associate Editor Anne Loh

Assisi Hospice Angela Yeo Bright Vision Hospital Muhammad Azhar bin Abdul Rahim Buddhist Compassion Relief Tzu Chi Editorial Team Tzu Chi Foundation (Singapore) 1 Lorong 2 Toa Payoh #07-00 Changi General Hospital Rasidah bte Alias Dover Park Hospice Jenny Goo Braddell House HCA Hospice Care Toh Wei Shi Singapore 319637 Khoo Teck Puat Hospital Ong Min Li T: 6538 2231 Lien Centre for Palliative Care Jessica Goh Siew Hong Metta Hospice Care Souriyasack Sinnie Julie Anne E: [email protected] MWS Home Hospice Nicole Andrea Tan www.singaporehospice.org.sg Singapore Cancer Society Kumudha Panneerchelvam St Andrew’s Community Hospital Peh Lay Koon St Joseph’s Home Shereen Ng Contents are not to be quoted or reproduced without the prior St Luke’s Hospital Chua Hwee Leng written permission of the Singapore Hospice Council. Tan Tock Seng Hospital Dr Ho Si Yin Tsao Foundation Desiree Lim

Design Christian Subrata Printer Yung Shung Printrade Pte Ltd

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2019